health.carpal-tunnel-syndrome.1.rme

#2018#07#06 #health #carpal-tunnel-syndrome #info #multi-series

(This information culled from techinfo.mit.edu -- just telnet to it.
A very spiffy service, I must say. -- dwallach)

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After this message was sent out, I started having quite severe problems
with my right wrist, and having seen this message, began to worry that
it might be carpal tunnel.  I went to the med center and the doctor
confirmed that it was in fact an early case of carpal tunnel.  He gave
me a wrist brace to wear, and told me to take ibuprofen when I had
problems.  Ibuprofen helps a lot.  If any of you have questions about
this, please talk to me, as I've learned quite a bit about it (not by
choice, though).
                                                -MESSAGE FROM CHRIS VANHAREN.


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The following message was sent out by a 6.170 student.  She makes some
points that are generally valuable for all of us to know about.

This message has very little to do with 6.170, but since you will all be
doing intense ammounts of typing this term and probably in the future,
you should know about Carpal Tunnel Syndrome.  I apologize to all those
who already know about this.

Carpal Tunnel Syndrome is an advanced form of Forearm Overuse Syndrome
and tendonitis in the wrists.  Basically, the bones in your wrist form a
3-sided tunnel (called the Carpal Tunnel).  Your tendons, blood vessels
and nerves pass through this tunnel.  If your tendons swell up too much,
it can pinch your blood vessels and nerves, causing numbness in the
fingers.  If it is ignored, permanent damage can occur.  Even if it
doesn't advance to the numbness stage, it is extremely painful and can
render your hands prettyuseless.

In the past, mostly factory workers were the victims of this type of
injury, which is caused by repetitive motion (aka Reptitive Motion
Syndrome.)  However, most cases now are related to computer use. I
developed this infliction last year when i was taking 6.170.  I
developed pain in my wrists, that sometimes ran from my fingers all the
way to my elbow.  I was stupid and ignored it,thinking it would go away
as soon as the  class was over and i got to take a rest from typing.  I
rested it 3 weeks and it seemed fine until i started typing again at my
job.  The pain got worse and worse until i could barely write, or even
tie my shoes.  Then one day i woke up and i couldn't feel the tips of my
fingers. I ran to the med center.

I had both my hands in casts, and then splints for the remainder of the
summer. Even though I've taken almost 6 mos. of rest from typing, i
still experience severe pain whenever i type. (Not good news for a 6-3).
Almost a year later, I am taking strong anti-inflamatory medication and
pain killers (equal to 7 Advil) everyday.  I am in physical therapy 3
times a week getting ultrasound treatment, and i ice my wrists all the
time.  My orthropedic doctor has diagnosed it as chronic, although we
are trying everything to correct it, possibly even surgery.  Basically,
I'm trying to say that this is VERY SERIOUS.It can really interfere with
your career...  And it CAN HAPPEN TO YOU!!!My doctor says he currently
has 15 cases of students with chronic variations of Forearm Overuse
Syndrome.

I probably got this because I typed wrong.  Do the following to avoid
developing CTS/Tendonitis:

1) Keep your wrists UP while typing.  DO NOT PUT YOUR WRISTS ON THE
TABLE!!! It might seem uncomfortable at first, but you'll get used to
it.
KEEP YOUR WRISTS UP!  KEEP YOUR WRISTS UP!  This is VERY important.

2) If you feel your wrists might need support in the "up" position, put
a pillow under them or something.

3) Make sure you are using the Shift Keys properly.  Do not hit the
shift key with the same hand you hit the other key.

4) Try switching your mouse to the left side now and then if you are a
righty,and viceversa for lefties.  There are lefty configured
workstations in
38-344.

5) Make sure that the key board is low enough.  It should not be too
high, so that you would have the temptation to rest your forearm on the
table.If the keyboard is too high (as it often is in Athena clusters)
put the keyboard in your lap.  Good posture while typing can make an
amazing difference.

6) If you experience any pain, ice it and Go to the Med Center.

7) If it hurts too much to type, for God's sake, give your hands a rest.
I worked through it last year, and I got a good grade in 6.170, but i'm
not sure if that good grade was worth screwing up my hands for possibly
the rest of my life (not very optimistic, i know.)  I'm currently
looking into Law School since I don't know what else I'd be able to do
if I can't get rid of this... :)

Sue

==================


Date: Wed, 27 Jun 90 09:40:34 CDT
From: meyering@cs.utexas.edu (Jim Meyering)
Subject: info on carpal tunnel syndrome (CTS)
    [Submitted via werner@cs.utexas.edu (Werner Uhrig)]

A friend suggested I read the following message (once posted to the sci.med
newsgroup).

I think it should interest anyone who types a lot.

One point the author does not mention is that the "force-depression curve" of
your keyboard may also play a role.  It is better to have a linear relationship
between force and depression.  But the keys on some keyboards require greater
force to depress the first few millimeters than the last few.  This gives what
is sometimes hyped as "positive-touch" or something similar.  The net result is
that you have to press (relatively) hard to get over the "hump," then with the
low resistance beyond it, your fingers bang into the base with more force than
with "linear" keyboards.  People have suggested that this sort of dynamic may
aggravate or even induce CTS.  Many of our HPs have this "nonlinear" keyboards.
The keys on some Sun3 keyboards have become so sticky that they give the same
effect.

Jim Meyering    meyering@cs.utexas.edu    uunet!cs.utexas.edu!meyering

=========

From: Andrea Frankel <andrea@sdd.hp.com>

Carpal Tunnel Syndrome:

This is a slightly edited reposting; apologies if you've seen it before,
but many people who read this on an internal HP notes group have found
it useful and asked for it to be more widely distributed.

Disclaimer:  I am not a doctor (but I sometimes play one on the Net ;@).
This is from my own personal experience with the malady, supplemented by
a little research and lots of talking to doctors and such.  Carpal
Tunnel Syndrome is being seen more and more frequently among the
computer set (my neurologist jokingly refers to it as "hacker's hand");
when caught early, conservative treatment can completely cure it.
However, if you let it go on long enough you can cause irreversible
damage.  If you have any question at all, PLEASE SEE A DOCTOR!  Better
safe than sorry.

1.  The setup

The bones in your wrist form a 3-sided tunnel, with the fourth side
closed off by a very tough piece of cartilage.  In this carpal tunnel
run the tendons of the muscles which flex your fingers, as well as the
very important median nerve which ennervates the thumb and the first two
fingers.

If something happens to cause the contents of the tunnel to swell, or to
cause the tunnel itself to get smaller, the pressure exerted on the
median nerve results in carpal tunnel syndrome.  Pregnancy, sudden
weight gain, drugs which cause water retention, and repetitive overuse
(or abuse) which causes tendinitis in those flexor tendons, can all cause
carpal tunnel syndrome.  (I recently learned that hypothyroid condition
can also cause CTS.)

Positions where the wrist is bent back while being used really
exacerbate the problem (e.g. bicycling with drop handlebars, if you are
not careful about hand positioning).

Other things can contribute as well - if you are doing carpentry in your
spare time and twisting many screws by hand, for example.  When you
become aware of the problem, start becoming aware of both the wrist
position and the stresses on it in various activities.

The median nerve runs up the heel of the hand onto the palm, along the
"life line".  Direct repeated blows to this area can mimic or add to the
carpal tunnel syndrome, and are often lumped in with it.  Our HP
keyboards are awful in this respect.  Kayaking, bicycling, gardening
without heavy gloves, all sorts of things can bang on this exposed
nerve.

2.  The symptoms and diagnosis

Any or all of the following:  pain, numbness, tingling, or sensations of
fullness in the fingers, hands, or shooting up or down the arms.

Quick test #1:  make an "O" with thumb and forefinger, insert the thumb
and forefinger of the other hand, and resist while trying to force the
"O" apart with the other hand.  The "O" should not come apart!

Quick test #2 (Tinnel sign):  place the backs of your hands together,
bend each hand 90 degrees towards the inner wrist, fingers pointing down
(forearms parallel to the floor, held out in front of you).

=======oo=========     key:  === forearms
       ||                    o   wrists
       ..                    |   metacarpals
       ..                    .   fingers

Press the backs of the hands together and hold for 30-60 seconds.  If
you start getting some numbness or tingling or pain, this is suspicious.

Loss of grip strength is a sign that you may have a more advanced case.
(I finally sought help when I was unable to open a can of tuna fish with
a standard Swingline manual can opener.)

I believe the best specialist for diagnosis is a neurologist.  A
neurologist will do nerve conduction studies, comparing rates of
conduction above and below the wrist, and between hands.  A good one
will also do electromyography, to see if the muscles enervated by the
nerve are firing properly or not.  (As a techie, I was fascinated to
watch the 'scopes while he poked me!)

3.  The treatment

Standard treatment is to start with the most conservative, least
invasive approaches, and move up only if they don't help.  The old
RICE formula - rest, ice, compression, and elevation - is the place
to start, but omit the compression as this is not a muscle strain.

A wrist splint (basically a velcro-and-ace-bandage type of thing with a
bent metal strip in it to hold the wrist in the right position) is worn
at night for a month to see if it helps; it can also be worn during the
day for stretches.  (Do not make it tight - it is for positioning only.)
In many cases, that plus correcting one's work habits is sufficient.
Some people find that a month is all it takes; others use the splint at
night for the rest of their lives, or off and on as needed.  I still use
mine occasionally when I've been overdoing it.  It's also a good idea to
wear it in situations where you might be tempted to do something silly
(like lugging suitcases or lifting weights), both as protection and as a
reminder to be careful.

Non-steroidal anti-inflammatories (e.g. Motrin) are used, if it looks
like inflammation is a major cause of the problem.

Icing the wrist helps alot, both for the pain and the swelling.  (Be
aware that over-icing has a rebound effect as the body attempts to warm
the area by increasing circulation.  Best is to ice for 10-20 minutes
max each time, leaving at least an hour between icings.)  I keep a
couple of the soft gel-type blue ice packs in a little fridge near my
desk, so that I can ice several times a day if I need to.  Bags of
frozen peas work great (hit 'em a couple whacks on the counter to
loosen them up, then pat the bag around your wrist so it conforms
to the curves).  For obvious reasons, jacuzzis (especially if you
leave your arms in) will tend to make things worse.

If water retention is a problem, you might try a mild OTC diuretic.
(Women:  it isn't uncommon for CTS symptoms to be worse during PMS
time.)  Also, simply elevating the wrist (for example, resting it on the
back of a padded chair or car seat, or sleeping with your splinted wrist
wresting next to your head on the pillow) can help relieve some of the
discomfort at least temporarily by reducing the swelling.

As a long-time fan of vitamins, minerals, and Prevention magazine,
I of course asked my doctors about B6 as a treatment for CTS.
Unfortunately, the original article reporting success from B6 treatment
was not reproducible by other experiments.  What's more, excessive doses
of B6 (over 50 mg/day supplement to a normal diet) can actually cause
peripheral neuropathy, mimicking some of the symptoms of CTS.  My doctor
said it wouldn't hurt if I wanted to take up to 50 mg/day, but since I
had been taking that amount for quite some time for other reasons, he
advised against increasing it.

Some doctors go for cortisone injections, although mine cautioned that
the carrier substance is not well absorbed, and can actually make the
problem worse by increasing the fluid pressure in the tunnel.  Your doctor
will decide based on the type of CTS and how it is responding to other
treatment (or not).

The final stage is surgery.  I had mine a few years ago; if you're
facing it, I'd be glad to chat with you about it.  The surgery itself
was a piece of cake, taking maybe 10 minutes once I was fully prepped -
very simply, they slit that piece of cartilage along the "life line" and
onto the wrist, and it spreads apart before it heals up, making the
tunnel larger.  Instant relief, although the recovery and rehab takes a
couple months.  For those interested in such things, I talked them into
skipping general anaesthesia in favor of a Bier Block, which worked
splendidly - I was out of there and wolfing down antipasto and garlic
bread an hour after surgery.

A friend notes that not everybody who has had the surgery finds it a
piece of cake.  His advice would be to make sure you have absolutely the
best doctors when it come to surgery on one's hands, with which I heartily
concur!  Hands are incredibly complex, considering all the different types
of finely coordinated movement they are capable of (and all the muscles and
nerves that requires).

I would strongly recommend that you look for an orthopedic surgeon who
is board certified in Hand Reconstruction Surgery - my scar is almost
invisible, compared to some pretty horrific looking ones I've seen.  (I
asked the neurologist, who was really top-notch, to look through my CCN
[preferred provider] booklet and recommend someone to me.)  An
orthopedic surgeon who handles a little bit of everything - shoulder
tears, knee arthroscopy, back problems - probably won't be as good at
carpal tunnel surgery as someone who spends their entire professional
life specializing in the elbow down.  For example, my surgeon stopped
the surface cut at the first wrist fold, lifted the skin, and continued
the surgery under the skin to minimize the scarring; other surgeons (who
don't specialize in hand reconstruction surgery) often don't think to do
that.  It doesn't affect how effective the surgery is, but it sure makes
a difference in how pretty your hand looks afterwards!

4.  The progression

The symptoms may come and go with heavy bouts of typing, bicycling, etc.
When it gets really bad, it can hurt all the time or start aching
spontaneously.

In the early stages, relieving the pressure on the median nerve will
quickly reverse the symptoms (in a matter of days to weeks).

Untreated, the pressure on the nerve will eventually cause it to die
back to the point of constriction.  When this happens, the muscles
atrophy.  (The large adductor which forms the mound at the base of my
thumb had shrunk to half its size by the time I was operated on.)

If you don't catch it quickly at that point, the nerve sheaths (which
the nerve had been inside before it died back) start to fray.  This is
bad news.  If you have surgery while the sheaths are still intact, the
nerve will grow back along the sheath (around 2 mm/day - you can
actually track it!)  and pretty much recover all of its connections and
functions.  I have a tiny patch less than 1/4" diameter on two finger
tips which is numb, and otherwise have full function back.  If the nerve
sheaths have frayed, however, the nerve can't find its way back to make
the right connections, and you're screwed.

IF YOU THINK YOU MIGHT HAVE CARPAL TUNNEL SYNDROME, GET IT LOOKED AT
*NOW*!!!  Don't delay, or you might not make a full recovery.  Workman's
comp studies looking at prognosis for recovery give very low odds,
based on most factory workers (who used to account for most of the CTS
claims before computeritis hit) being too macho or too scared of losing
their jobs to file a claim before it was too late.

5.  Prevention

The optimal position for your wrist is with the hand bent back just
20-30 degrees; you want the position where the front of your wrist
makes a straight line with the first inch of the heel of the palm.
Play with it a bit until you find the place where the wrist seems
to be maximally "open", but without bending the hand back so far that
you feel strain.

Look down at your hands as you type - if you are dropping your wrists,
you are at risk.  Think about how they used to teach piano technique:  an
almost straight line along the back of the forearms, through the wrist, onto
the back of the hand; fingers dropping down.  (My sister's piano teacher
used to place pennies on the back of her hands while she played, to
teach keeping it level.)  Practice typing that way, and instead of
resting the heel of your hands on the edge of the keyboard when you're
thinking or reading, rest them in your lap instead.

I got a very nice padded wrist rest from a local office supply house,
that allows me to rest my forearms or wrists while I type in this
position; I have one under my 320 keyboard, and one for my Vectra.
You can also improvise by taking a length of bubblewrap, rolling it up
and securing the ends with rubber bands, then taping the roll to your
desk in front of the keyboard.  Warning:  this padded wrist rest can
actually make it worse for some people, if it distorts the normal typing
motion or presses too hard against the wrist.

I currently have a keyboard draw from Devoke (about $115) that has a
full 6" height adjustment, slides in and out and swings to both sides.
It mounts with two screws, and I have one in the "L" of my workstation
table at work, and on the desk at home where I have my PC.  This has
made the most difference when my CTS flared up again (along with rest
and splinting).

Wear padded gloves for anything which might bang on your hands.  Bicycling
gloves with Spenco pads can be used for many things (I wear mine ice
skating!).  The Spenco pads are definitely superior to leather or other
types when it comes to cushioning that area against shocks.  (After the
surgery, I was warned that the median nerve would always be a bit more
exposed and sensitive, and it definitely made me a connoisseur of bicycling
gloves!)

Learn to back off when you realize you're about to lift or torque
something heavy with your wrist bent.  If you can't rethink the movement
so you can keep your wrist straight, get help (person or tool)!

p.s.  Feel free to copy and distribute this to anyone who might be helped.
I only request that you not delete anything, especially the disclaimer.

Andrea Frankel, Hewlett-Packard (San Diego Division) (619) 592-4664
UUCP     : {hplabs|nosc|hpfcla|ucsd}!hp-sdd!andrea
USnail   : 16399 W. Bernardo Drive, San Diego CA 92127-1899 USA

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Return-Path: <sollins@allspice.lcs.mit.edu>
Date: Thu, 9 May 91 13:50:44 EDT
From: Karen Rosin Sollins <sollins@lcs.mit.edu>
Sender: sollins@allspice.lcs.mit.edu
To: elias@theory.lcs.mit.edu
Subject: carpal tunnel syndrome and tendonitis

I have just gone through a bout of this.  I have chronic arthritis,
but over the last few weeks, something different happened - a form of
tendonitis in my wrists and hands.  It is much better now, but it
brought home how incapacitating these problems can be.  The number of
things I couldn't do was astounding - open doors, eat with a fork or
spoon, it gets down to real basics.  As I'm sure you know from having
gone through this, when it gets bad it just hurts all the time and we
do a great deal with our hands.  The most well-known hacker in our
community who has this problem is Richard Stallman, who no longer can
type at all.  For at least a year or more, he has had hired typists to
whom he dictates everything.  I've known other people who are in the
same condition.

Actually, I first learned of carpal tunnel syndrome because for some
reason it is more common among women, especially as they reach 40 and
older.  It is also common during and after pregnancy, so it is
something that women should be especially aware about because they are
more likely to get it later, if they don't get it as undergraduates.



Date: Thu, 28 Jun 90 09:06:49 -0400
From: Mike Tanner <tanner@cis.ohio-state.edu>
Subject: Re: info on carpal tunnel syndrome (CTS) (RISKS-10.12)

At the risk of turning this into a medical forum I wanted to add to the
excellent summary on carpal tunnel syndrome that there is a related problem
called ulnar nerve syndrome.  As with CTS, those of us who spend lots of time
using keyboards are prone to ulnar nerve syndrome, too.  The main difference
in the symptoms is that with CTS the numbness and tingling is in the thumb and
first two fingers, with UNS it is in the other two fingers and along the
outside of the forarm.  (When you "hit your funny bone", what you've done is
bash your ulnar nerve.  The symptoms are similar to that feeling, but they
don't go away.)

My wife's neurologist (she's been going through a bout of it) said there are
many causes, but a common one is some activity that constantly rubs the elbow.
In her case it is almost certainly typing while resting her elbows on the arms
of a chair.  One danger is that carpal tunnel syndrome is so hot, such a fad
right now, that a physician might automatically connect "numbness" with
"programmer" and say "carpal tunnel".  My wife's physician did this, and only
changed his mind after we had looked in some medical books and found that CTS
symptoms did not match hers.  (Physicians deny that they reason this way.
Experience tells otherwise.)

Treatment is basically like CTS:  ice, avoid bending the elbow as much as
possible (not easy to do), don't do things that rub the elbow a lot,
anti-inflammation drugs.  There is surgery, but unlike CTS, ulnar nerve
surgery is not a good option.  Apparently it has about a 50% chance of making
things worse, according to my wife's neurologist.  (That might have been an
estimate that took the nature of her condition into account, i.e., there are
cases where it has a high probability of success, but hers isn't one of them.)

-- mike

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Date: 29 Jun 90 19:36:47 GMT
From: tok@stiatl.UUCP (Terry Kane)
Subject: Re: info on carpal tunnel syndrome (CTS)

I am a long time sufferer of CTS.  The first symptoms I recall were during
high school, nearly twenty years ago, but it was not properly diagnosed
until I was in excruciating pain, dropping things, not sleeping because
my hand was burning at night and more, all about four years ago.

Tests said that I had "a very mild case"!?  That reassuring info did not
make my hand better.  I used splints, Motrin, ice until I finally insisted
on the carpal tunnel relief operation.  That was two years ago, this month,
but I still have recurrences - especially when I meet the same RISK which
pushed my CTS over the edge: using a MOUSE.

The typical mouse promotes all the bad habits that can result in CTS symptoms.
One typically rests the heel of the palm on the mouse, and press the chord
keys - frequently with constant pressure (on Apple's mice, the required
pressure is substantial for me, and their new mouse reqlly aggravates the
problem with its stylized, aerodynamic "look").  I cannot use a mouse to this
day without suffering a "mouse hangover".

Track balls are better for me, but I still would rather avoid them.

I am really looking forward to _getting_my_hands_on_ ;-) a touch screen.
I've seen some very nice ones with quite satisfactory resolution!

And please - If you think that you might have CTS - don't waste time.
                        See Your M.D.

Terry Kane, Sales Technologies, Inc, Atlanta, GA  (404) 841-4000

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